ACOG: Calling for Maternal Safety Bundles

There are nearly 4 million births a year in the U.S., and almost 60% of those deliveries occur at hospitals with fewer than 1,000 births a year. That amounts to roughly 3 births a day -- compared to 11 a day at a major metropolitan hospital -- and for hospitals in extremely rural areas it's even less than that.

The most recent notable articles about the increases in maternal morbidity -- "Deadly Deliveries" in USA Today and the "Lost Mothers" series by ProPublica and NPR -- have raised public awareness and concern among U.S. women, providers, and communities about the dangers of childbirth. In those articles is a search for answers.

While maternal deaths rarely occur due to a single factor, we can point to specific contributors, including a greater prevalence of comorbidities in women, such as obesity, hypertension, diabetes, and heart disease. Other factors may include the advancing age of women having children and increases in cesarean delivery rates.

Additionally, lack of access to care and the fragmentation of prenatal and delivery services in many rural communities have become risk factors for a large number of women across the country. Health outcomes are worse and healthcare disparities are more pronounced because poverty and lack of resources are more common in many rural communities.

Cardiovascular disease, substance abuse, opioid addiction, depression, and suicide are also leading contributors to the maternal mortality problem in the U.S., and we are seeing these issues emerge in rural populations at alarming rates. Team-based and coordinated care is fundamental to addressing these conditions and is an important element in a quality-focused and safety-focused obstetrical practice.

Healthcare providers and obstetrical teams must know how to consistently manage common preventable pregnancy complications, such as hemorrhage, hypertension, and thromboembolism. For example, in cases of severe hypertension, hospitals and staff must be trained and have access to appropriate medication to lower blood pressure, which must be given in a timely manner based on hospital protocol. Every hospital, regardless of size, should have best practices for treating hemorrhage and prevention guidance for thromboembolism, which must be followed for every woman undergoing cesarean delivery.

Through the Alliance for Innovation on Maternal Health (AIM), best practices in maternal care, or safety bundles, are being rapidly adopted by an increasing number of hospitals across the U.S. This program relies on state teams, comprised of hospitals, state health departments, perinatal quality collaboratives and provider groups, and focuses on maternal safety and quality improvement. And it's working. Four states that were the first to join the AIM initiative have shown early signs of improvement in severe maternal morbidity.

However, there is more work to be done. It is critical that delivery services develop protocols based on these AIM bundles and have a team-based model for assessing risks, regardless of hospital size. Hospital leadership must insist on obstetrical quality and safety team training and maintenance programs in every hospital, regardless of level. There must also be systems in place to collaborate and communicate with other hospitals in the region.

The American College of Obstetricians and Gynecologists (ACOG) Levels of Maternal Care (LoMC) program helps facilitate these efforts. This program assesses the complexity of maternity care that a hospital is able to provide. It also supports collaboration with other institutions within a region to ensure women, particularly those with high-risk pregnancies, can be transferred to a facility that best meets their needs. States and hospitals are increasingly adopting the LoMC format, and Texas recently mandated that hospitals have a level of care designation for maternity services to receive payment from the Medicaid program.

ACOG supports the use of telemedicine to assist communities and providers in implementing AIM, LoMC, and community-based care in clinics and hospitals to streamline protocols, guidelines, and collaborations for consultation and referral. For every maternal death, there are at least 50 near deaths, and these programs are designed to help prevent or address cases of severe morbidity in addition to preventing mortality.

Through these efforts and others, hospital leadership, obstetrical providers and community advocates are working toward the common goal of ensuring healthy birth outcomes for women and families, regardless of where they live.

Lisa M. Hollier, MD, MPH, and Haywood L. Brown, MD, are the president and immediate past president, respectively, of ACOG, the nation's leading group of physicians providing healthcare for women. It is a private, voluntary, nonprofit membership organization of more than 58,000 members.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.